The nurse manager is mediating a grievance brought by the certified nurse aide (CNA) about the nurse after the CNA was unsuccessful in resolving the conflict. At the mediation session, the CNA repeatedly states that the nurse's delegation is unfair and overloading, while the nurse continues to repeat the reasons for the delegated activities. Which is the nurse manager's best course of action?

Rationale:

A. Confronting the nurse publicly is unprofessional and can escalate the situation. Concerns about potential impairment should be handled privately and through established protocols to ensure safety and compliance.

B. Following the facility’s impaired-provider protocol is essential. The staff nurse’s behaviors—tardiness, slurred speech, tremors, frequent bathroom breaks, and unsafe patient care—indicate potential impairment (e.g., substance use, mental health, or medical condition). Protocol ensures proper assessment, safety measures, and referral to Employee Assistance Programs or regulatory oversight.

C. Documenting objective findings (late arrivals, bathroom breaks, EMR discrepancies, observed physical signs) is critical for legal protection, professional accountability, and accurate reporting. Documentation should be factual, specific, and free of subjective judgments.

D. Reassigning the staff nurse’s clients immediately is necessary to protect patient safety. The nurse’s cognitive and physical signs of impairment pose a direct risk, and other staff should assume care until the situation is evaluated.

E. Allowing the staff nurse to continue working based on a promise is unsafe. Immediate action is required to protect patients, regardless of verbal assurances.

F. Notifying the house supervisor ensures that leadership is aware, additional resources are mobilized, and institutional protocols for impaired providers are followed. This allows for proper escalation and regulatory compliance.

Rationale:
A. The first and immediate action after a needle stick injury is to wash the site thoroughly with soap and water. This is a standard infection control procedure to reduce the risk of pathogen transmission, including bloodborne pathogens such as HIV, hepatitis B, and hepatitis C. Immediate cleansing of the wound is prioritized before any other steps.

B. Incorrect as the first action. Postexposure prophylaxis (PEP) with antiretroviral medications is important but should be initiated after the site is cleaned and exposure is assessed. Starting PEP without first washing the wound does not follow proper safety protocol.

C. Obtaining consent for the client’s HIV testing is part of the follow-up procedure but is not the immediate first step. Immediate personal safety measures take priority over documentation or testing of the source.

D. Completing an incident report is required for legal and institutional documentation, but it is not the first priority. Patient and nurse safety come before administrative steps.